Director of Utilization Review

Director of Utilization Review (RN) – Permian Basin Behavioral Health Center

Signet Health is seeking an experienced Director of Utilization Review (RN) for a BRAND NEW hospital – Permian Basin Behavioral Health Center, located in Midland, Texas.  The facility is scheduled to open late Spring 2026. 

The Utilization Review RN is responsible for ensuring that all behavioral health patients receive the appropriate level of care, and that all services rendered meet medical necessity, payer requirements, Texas Behavioral Health regulations, and DNV accreditation standards.

The UR RN performs utilization review activities, concurrent reviews, precertifications, and discharge-related authorization functions to support timely reimbursement and high-quality patient care.

Signet Health is one of the larger behavioral health management companies in the United States with programs nationwide.  We are staffing and managing this brand-new hospital.

We offer a competitive and comprehensive compensation package. 

Responsibilities Include:

Utilization Management & Medical Necessity

• Conduct admission, continued-stay, and discharge reviews for all patients based on:
  • InterQual®, MCG, or payer-specific medical necessity criteria.
  • CMS Conditions of Participation (where applicable).
  • DNV NIAHO® Behavioral Health standards.
• Validate appropriate level of care (inpatient, PHP, IOP, detox, residential).
• Identify and communicate variances to medical necessity, collaborating with providers to resolve clinical or authorization barriers.

Insurance & Authorization Management

• Initiate pre-certifications for admissions and transfers.
• Perform concurrent reviews with commercial, Medicaid, Medicare Advantage, and managed care organizations.
• Submit clinical documentation within required time frames to prevent denials.
• Manage peer-to-peer requests and escalate cases to physician advisors as needed.
• Track and document authorization numbers, approved days, and review dates in EMR and UR software.

Compliance & Accreditation (DNV / Texas-specific)

• Ensure UR processes comply with:
  • DNV NIAHO®/ISO 9001 requirements for utilization management.
  • Texas Administrative Code Title 25—Behavioral Health Facility regulations.
  • CMS, EMTALA (if applicable), and payer rules.
• Participate in audits, tracer activities, and performance improvement projects.
• Maintain accurate and complete documentation that meets DNV documentation standards.

Interdisciplinary Collaboration

• Work with physicians, nursing, case management, therapy, social work, and admissions to coordinate patient flow and progression of care.
• Attend daily treatment team meetings on assigned units.
• Communicate authorization status, updates, and denials to clinical teams.

Denial Prevention & Management

• Identify potential denial risks early and intervene proactively.
• Assist with preparation of denial appeals, supplying clinical summaries and supporting documentation.
• Work with billing and revenue cycle to ensure claim accuracy and timely submission.

Documentation & Data Management

• Enter all reviews, payer communications, and clinical updates into the EMR/UR tracking system.
•  Maintain UR logs, KPIs, and dashboards for:

o LOS monitoring
o Denial rates
o Approval trends
o Payer mix and reimbursement

o Report trends to leadership for process improvement

Qualifications:

• Current Texas RN license (unencumbered).
• Minimum 2 years psychiatric/behavioral health nursing experience.
• Experience with utilization review, case management, or managed care.
• Knowledge of InterQual®/MCG criteria.
• Strong understanding of behavioral health diagnoses, treatment modalities, and levels of care.
• Excellent communication and negotiation skills.

Preferred

• Prior UR/UM experience in a Texas behavioral health facility.
• Familiarity with DNV Accreditation (NIAHO®/ISO 9001).
• Experience with Medicaid/Medicare behavioral health authorization processes.
• Experience with EMRs such as Epic, Cerner, MediTech, or Sigmund.

CORE COMPETENCIES

• Clinical assessment and critical thinking
• Knowledge of utilization review criteria
• Strong professional communication
• Time management and organization
• Understanding of behavioral health regulations
• Accuracy and attention to detail
• Collaboration and conflict resolution
• Ethical decision-making

PHYSICAL & WORK REQUIREMENTS

• Office-based with regular unit rounds and team meetings.
• Ability to type, sit, or stand for extended periods.
• Occasional lifting of files or equipment (<20 lbs).
• Must maintain confidentiality and meet HIPAA, DNV, and Texas regulatory standards.

ADDITIONAL DUTIES

• Participate in staff training related to utilization management.
• Support hospital-wide performance improvement projects.
• Assist with payer education and communication initiatives.
• Other duties as assigned by the Director of UR or Clinical Leadership.

Living in Midland, Texas adds to the appeal, offering a high quality of life with affordable housing, short commutes, excellent schools, and a welcoming community. Midland blends small-city convenience with big-opportunity energy, featuring a vibrant arts scene, outdoor recreation, and easy access to regional travel—making it an ideal place to grow both professionally and personally.

Working at Permian Basin Behavioral Health Center offers the rare opportunity to be part of a brand-new, mission-driven organization that is transforming access to behavioral health care across West Texas and Southeastern New Mexico. Team members play a meaningful role in building programs, shaping culture, and directly impacting lives in a growing region with a strong sense of purpose and collaboration.

Transforming Lives. Restoring Hope.

Permian Basin Behavioral Health Center (PBBHC) is a new, comprehensive mental health center serving the Permian Basin region of West Texas and Southeastern New Mexico. Conveniently located between Midland and Odessa, PBBHC will offer both inpatient and outpatient behavioral health services for individuals of all ages.